4.1 The first hours

Promotional poster - from Baby Friendly UK
The benefits to the mother of immediate breastfeeding are innumerable, not the least of which, after the weariness of labour and birth, is the emotional gratification, the feeling of strength, composure, and the sense of fulfillment that comes with the handling and suckling of the baby.1
Ashley Montague, 1978
Baby Friendly Step 4
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Step 4 of the Ten Steps to Successful Breastfeeding states:
"Help mothers to initiate breastfeeding within a half-hour of birth." This step is now interpreted as:
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Immediately following birth
At the time of birth nearly 90% of newborns are vigorous, term babies with no risk factors, who do not need to be separated from their mother in order to receive the initial steps of resuscitation.3
- Immediately move newborn onto mother's abdomen with skin-to-skin contact.
- In this position: Upper airway can be cleared by wiping the mouth and nose, baby can be dried, assigned Apgar scores, visually assessed and vital signs recorded.
- Cover both mother and baby with dry linen.
The first breastfeed
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![]() | ![]() Read this great article!What happens now is truly a miracle to watch! Click on the icon on the left to read this paper, then file it in your Workbook. If you are in contact with colleagues who are with birthing mothers, share it with them too. | ![]() |
Several researchers have described this species-specific set of innate behaviors when baby is placed in skin-to-skin contact with the mother immediately following birth. It is clear that newborn babies are born with the instinct to breastfeed.4,5,6,7

© R.Cantrill, IBCLC
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![]() | ![]() Research findings
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The role of the birth attendants
This critical period in the relationship between mother and baby is, in some birthing units, a high-intervention time when it should be exactly the opposite. Recall that the AAP Neonatal Resuscitation Program3 states that all observations can take place with infant in skin-to-skin contact with his mother. The role of the birth attendants at this time is to support the mother to provide the ideal environment for her baby to adapt to extrauterine life, orientate to the breast and coordinate suckling.
Appropriate support is given by discussing with the mother, and others present, the importance of uninterrupted skin-to-skin contact. Some birth attendants tell of the mother and her support people being enthralled as they watch the baby move through this sequential pre-feeding behavior, not wishing to interrupt it. A little education can go a long way!
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![]() Workbook Activity 4.2Complete Activity 4.2 in your workbook. |
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Addressing barriers to skin-to-skin
Concern that the baby will get cold.
- Dry the baby and place in skin-to-skin contact on mother's chest.
- Put a dry cloth or blanket over both the mother and the baby.
- If the room is cold cover the baby's head with a bonnet to reduce heat loss.
- Babies in skin-to-skin contact have higher temperature than those dressed and better temperature regulation than those under a heater or in incubator care. 10 11
Baby needs to be examined.
- Most examinations can be conducted with baby on mother's chest.
- There is no need to move the baby to monitor vital signs.
- Weighing can be delayed.
Mother needs to be stitched.
- Baby can stay on mother's abdomen while stitching an episiotomy.
- Baby can stay on mother's chest while stitching a caesarean section.
Baby needs to be bathed.
- Delaying the first bath provides better thermoregulation and allows the vernix to remain on the skin.
Delivery room is busy.
- Mother and baby can be transferred to the postnatal ward while in skin-to-skin contact.
Insufficient staff to remain with the mother.
- A family member can stay with the mother and baby.
- Discuss routine precautions with the family member to ensure their safety.
Baby is not alert.
- If a baby is sleepy due to maternal medications it is even more important that the baby has contact as he/she needs extra support to bond and feed.
Mother is tired.
- A mother is rarely so tired that she does not want to hold her baby.
- Contact with her baby can help the mother to relax.
- Review labor practices such as withholding fluid and foods, and practices that may increase the length of labor.
- Skin-to-skin care and breastfeeding is best when the mother is in a reclined or semi-reclined position; a good position for resting.
Lack of knowledge of health professional wishing to move the baby
- This first step following birthing has far-reaching effects on mother, baby and breastfeeding.
- Train all birthing room staff in the effects of immediate and undisturbed skin-to-skin contact.
- Refer all staff to the hospital policy which they must follow. Hospital breastfeeding policies will reflect the 10 Steps to Successful Breastfeeding, including Step 4.
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![]() | ![]() Just the thing for busy staff!Supporting the mother to care for her baby with skin-to-skin contact will significantly reduce the workload of the health care staff looking after her.
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Maternal-infant bonding
This is the beginning of a loving relationship between the parents and their newborn. The infant appears to play his part in the establishment of these bonds by actively interacting with his parents. Following an initial cry at birth the infant becomes quietly alert and seeks visual contact, massages the mother's chest and breasts and latches and breastfeeds. The high blood levels of beta endorphins, oxytocin and prolactin in both mother and infant facilitate falling in love.14
For this to occur the following factors have to be in place and considered. These are all influenced by the birth attendants.
- the availability of the infant to his/her parents,
- an environment conducive to parent and child interaction, and
- the attitude of those present at the delivery to the appearance of the infant14
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What about a baby to be artificially fed?Skin-to-skin time with mother is equally important for EVERY baby. In Topic 4.3 Postnatal interventions, you will read the effects of separating mothers and newborns - facilitating breastfeeding is only one of many, many benefits of skin-to-skin contact.
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What should I remember?
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Self-test quiz
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Notes
- # Montague A (1978) Touching: The Human Significance of the Skin
- # World Health Organization (2006) Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Intergrated Care
- # American Academy of Pediatrics (2000) The Textbook of Neonatal Resuscitation
- # Righard L et al. (1990) Effect of delivery room routines on success of first breast-feed
- # Widstrom AM et al. (1990) Short-term effects of early suckling and touch of the nipple on maternal behaviour
- # Varendi H et al. (1998) Soothing effect of amniotic fluid smell in newborns
- # Mattos-Graner RO et al. (2001) Relation of oral yeast infection in Brazilian infants and use of a pacifier
- # Gomez Papi A et al. (1998) Kangaroo method in the delivery room for full-term babies
- # Bergman NJ et al. (2004) Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns
- # Carfoot S et al. (2005) A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breast feeding.
- # Fransson AL et al. (2005) Temperature variation in newborn babies: importance of physical contact with the mother.
- # Visscher MO et al. (2005) Vernix caseosa in neonatal adaptation.
- # Bergstrom A et al. (2005) The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: a randomized, controlled trial.
- # Attrill B (2002) The assumption of the maternal role: a developmental process